Provider Demographics
NPI:1902938301
Name:IRIZARRY, JULIO A (DMD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:A
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 FLATBUSH AVENUE EXT # 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5381
Mailing Address - Country:US
Mailing Address - Phone:646-997-4300
Mailing Address - Fax:
Practice Address - Street 1:336 FLATBUSH AVE APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5283
Practice Address - Country:US
Practice Address - Phone:646-997-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114671223G0001X
NY0628951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice